KVV E-Modules - Clinical examination of Cardio Vascular System

Quadrant -I (Video)

Cardio Vascular System - Inspection

Cardio Vascular System - Palpation

Cardio Vascular System- Percussion

Cardio Vascular System- Auscultation

Quadrant - II (Study Material)

1. Clinical examination of Cardio Vascular System

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Quadrant - III (Assignments)

1. Cardio Vascular System – Inspection

1) What are the important findings to look for on inspection of the precordium? 2) What is the normal location of the apex beat on inspection? 3)What are visible pulsations, and which ones may be seen in cardiac diseases? 4)What chest deformities can affect cardiovascular examination 5) Define apex impulse 6) what are the causes of absent apex impulse 7) What is the importance of inspection of apex beat

2. Cardio Vascular System - Palpation

1) Define apex beat 2) What may be the reason of absent apex beat on Rt. Side? 3) How do you locate and assess the apex beat on palpation? 4)What are the different characteristics of the apex beat (location, intensity, character)? 5) What is a heave, and how is it different from a thrill? 6)What is a thrill, and what is its clinical significance? 7)How do you palpate for parasternal heave 8) What is your conclusion if apex beat is shifted to more to Lt. Side than normal?

3. Cardio Vascular System- Percussion

1) how do you start percussion for Lt. Border of heart? 2) how do you start percussion for Rt. Border of heart? 3) What is importance of percussing the Lt. Border? 4)What is importance of percussing the Rt. Border? 5)In which conditions is cardiac dullness increased? 6) Why is percussion of the heart less commonly used in modern clinical practice?

4. Cardio Vascular System- Auscultation:

1) What are the standard areas of auscultation of the heart? 2)What are the first (S1) and second (S2) heart sounds, and how are they produced? 3) What is a murmur, and how do you classify it? 4) What are added heart sounds (S3, S4), and what is their significance? 5)How do you use the diaphragm and bell of the stethoscope in cardiac auscultation? 6) Why do you need to palpate Carotid artery pulsations simultaneously with auscultation? 7) Mention 2 conditions where murmur is present

Quadrant - IV (MCQs)

The normal location of the apical impulse on inspection is:

A: Right 5th intercostal space B: Left 5th intercostal space, midclavicular line D: Left 2nd intercostal space D: Epigastrium

A visible heaving apex beat on inspection suggests:

A: Left ventricular hypertrophy B: Right ventricular failure C: Pericardial effusion D: Mitral stenosis

A visible heaving apex beat on inspection suggests:

A: Left ventricular hypertrophy B: Right ventricular failure C: Pericardial effusion D: Mitral stenosis

Which of the following may be seen on inspection in severe tricuspid regurgitation?

A: Carotid pulsations B: Epigastric pulsations C: Visible jugular venous pulsations D: Apex displacement

Inspection of precordium helps in identifying:

A: Heart sounds B: Murmurs C: Visible pulsations and deformities D: Blood pressure

The normal position of the apex beat in adults is:

A: 4th ICS, right MCL B: 5th ICS, left midclavicular line C: 6th ICS, left anterior axillary line D: 3rd ICS, left parasternal line

A visible pulsation in the epigastrium may indicate:

A: Left ventricular hypertrophy B: Right ventricular enlargement C: Aortic stenosis D: Mitral stenosis

Which chest deformity may affect cardiac examination?

A: Kyphosis B: Lordosis C: Scoliosis D: All of the above

A diffuse, hyperdynamic apex beat on inspection suggests:

A: Mitral stenosis B: Left ventricular hypertrophy C: Pericardial effusion D: Cardiogenic shock

Which condition may cause a displaced apex beat?

A: Pneumothorax B: Pleural effusion C: Cardiomegaly D: All of the above

Visible carotid pulsations are best seen in:

A: Aortic regurgitation B: Mitral stenosis C: Pulmonary stenosis D: Pericarditis

A retracted apex beat may be seen in:

A: Constrictive pericarditis B: LVH C: Dilated cardiomyopathy D: Hypertension

13) Which of the following is NOT a normal finding on inspection?

A: No visible pulsations B: Apex beat in 5th ICS C: Multiple abnormal pulsations D: Symmetrical chest movement

1. The apex beat is best palpated using:

A: Fingertips B: Palm C: Ulnar border of hand D: Dorsum of hand

A sustained and forceful apex beat indicates:

A: Volume overload B: Pressure overload (LVH) C: Pericardial effusion D: Normal finding

A thrill on palpation indicates:

A: Normal blood flow B: Turbulent blood flow due to murmur C: Decreased cardiac output D: Valve closure

Parasternal heave is indicative of:

A: Left atrial enlargement B: Right ventricular hypertrophy C: Aortic stenosis D: Mitral regurgitation

The normal location of the apex beat is:

A: 4th ICS, right midclavicular line B: 5th ICS, left midclavicular line C: 6th ICS, left anterior axillary line D: 5th ICS, right Parasternal

A heaving apex beat indicates:

A: Volume overload B: Pressure overload C: Pericardial effusion D: Normal finding

A hyperdynamic apex beat is seen in:

A: Aortic stenosis B: Mitral stenosis C: Aortic regurgitation D: Pericardial tamponade

A parasternal heave suggests enlargement of:

A: Left atrium B: Left ventricle C: Right ventricle D: Right atrium

The apex beat is produced by:

A: Atrial contraction B: Ventricular contraction C: Valve closure D: Blood turbulence

A displaced apex beat indicates:

A: Right ventricular hypertrophy B: Left ventricular enlargement C: Atrial fibrillation D: Valve stenosi

Palpable P2 indicates:

A: Systemic hypertension B: Pulmonary hypertension C: Mitral regurgitation D: Aortic stenosis

A tapping apex beat is classically seen in:

A: Aortic regurgitation B: Mitral stenosis C: Pericarditis D: Ventricular septal defect

Best position to palpate apex beat in difficult cases:

A: Supine B: Sitting upright C: Left lateral position D: Right lateral position

Cardiac percussion is used to assess:

A: Valve function B: Chamber size C: Heart sounds D: Blood pressure

Normal cardiac dullness is mainly due to:

A: Left atrium B: Right ventricle C: Left ventricle D: Pericardium

Icreased cardiac dullness may indicate:

A: Pneumothorax B: Cardiomegaly C: Emphysema D: Pleural effusion

Loss of cardiac dullness occurs in:

A: Pericardial effusion B: Cardiomegaly C: Emphysema D: Left ventricular hypertrophy

Percussion of heart is best done in:

A: Sitting position B: Supine position C: Standing position D: Prone position

Cardiac dullness merges with liver dullness at:

A: Left border B: Right border C: Inferior border D: Superior border

Right border of cardiac dullness is formed by:

A: Left ventricle B: Right ventricle C: Right atrium D: Left atrium

8. Percussion is least useful in:

A: Thin individuals B: Obese individuals C: Children D: Lean adults

The upper border of cardiac dullness corresponds to:

A: Atria B: Ventricles C: Great vessels D: Apex

10. Shifting cardiac dullness suggests:

A: Cardiomegaly B: Pleural effusion C: Pericardial effusion D: Pneumonia

The first heart sound (S1) is due to:

A: Closure of semilunar valves B: Closure of AV valves C: Opening of AV valves D: Atrial contraction

A loud S1 is seen in:

A: Mitral stenosis B: Mitral regurgitation C: Aortic stenosis D: Heart failure

An S3 heart sound indicates:

A: Normal in elderly B: Ventricular overload C: Valve stenosis D: Pericarditis

Pericardial friction rub is best heard with:

A: Bell B: Diaphragm C: Stethoscope removed D: Hand palpation

Pan-systolic murmur is seen in:

A: Aortic stenosis B: Mitral regurgitation C: Mitral stenosis D: Pulmonary stenosis

A loud S1 is seen in:

A: Mitral stenosis B: Mitral regurgitation C: Aortic stenosis D: Heart failure

An S3 heart sound indicates:

A: Normal in elderly B: Ventricular overload C: Valve stenosis D: Pericarditis

Best area to hear mitral valve sounds:

A: Right 2nd ICS B: Left 2nd ICS C: Apex D: Left lower sternal border

Pericardial friction rub is best heard with:

A: Bell B: Diaphragm C: Stethoscope removed D: Hand palpation

Pan-systolic murmur is seen in:

A: Aortic stenosis B: Mitral regurgitation C: Mitral stenosis D: Pulmonary stenosis

1st heart sound coincides with

A: Sound of inspiration B: Brachial artery pulsations C: Carotid artery pulsations D: Radial artery pulsations

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